Improving interprofessional team simulation learning. One more step towards the humanization of health care in emergency situations

Interprofessional education refers to the collaboration of students from different disciplines towards the resolution of a series of clinical situations. The general objective of this study was to analyze the perspective of the participants in interprofessional simulations (doctors and nurses) in emergency situations. Qualitative study with an inductive approach for the identification of categories derived from the opinions provided by the participants in interprofessional simulations was conducted (n = 58). Individual open-ended questions were provided through a self-completed qualitative questionnaire. The answers were subjected to a descriptive content analysis. Three emergent themes, 13 categories and 21 sub-categories were obtained. Emotions-related aspects, strengths, and areas to be improved were identified with respect to the interprofessional simulations. The participants highlighted the great closeness to reality, they felt comfortable and confident, and their positive emotions had a greater weight than the negative ones (uncomfortableness, frustration, and insecurity). The most prominent positive aspects were teamwork, the realism of the training, and the empowerment of the nurses. The areas that could be improved were those related to aspects associated with carrying out the simulations, the demand for joint planning, and the improvements in the development of the sessions by the facilitators (co-debriefers). This work demonstrates the good reception of the learning experience by the participants. Interprofessional simulations are great learning tools, although weaknesses were found that could be improved with adequate planning by the educators.

Interprofessional simulation; Interprofessional collaboration; Interprofessional team-work; Simulation training; Qualitative research

[1] Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. Journal of the American Board of Family Medicine. 2011; 24: 229–239.

[2] Alerte AM, Behme J, Kosowicz L, Nowicki T, Pfeiffer C. Inter-professional Teaching via Simulation in Medical Education. Medical Science Educator. 2013; 23: 414–416.

[3] Schmitt M, Blue A, Aschenbrener CA, Viggiano TR. Core Competencies for Interprofessional Collaborative Practice: Reforming Health Care by Transforming Health Professionalsʼ Education. Academic Medicine. 2011; 86: 1351.

[4] la Rosa-Salas V, Arbea Moreno L, Vidaurreta Fernández M, Sola Juango L, Marcos Álvarez B, Rodríguez Díez C, et al. Educación interprofesional: una propuesta de la Universidad de Navarra. EducacióN MéDica. 2020; 21: 386–396.

[5] Kyrkjebø JM, Brattebø G, Smith-Strøm H. Improving patient safety by using interprofessional simulation training in health professional education. Journal of Interprofessional Care. 2006; 20: 507–516.

[6] Omer T. Nursing Students’ Perceptions of Satisfaction and Self-Confidence with Clinical Simulation Experience. Journal of Education and Practice. 2016; 7: 131–138.

[7] World Health Organization (WHO). Transforming and scaling uphealth professionals’ education and training. 2013. Available at: https://apps.who.int/iris/bitstream/handle/10665/ 93635/9789241506502_eng.pdf (Accessed: 12 June 2020).

[8] Costello M, Huddleston J, Atinaja-Faller J, Prelack K, Wood A, Barden J, et al. Simulation as an Effective Strategy for Interprofessional Education. Clinical Simulation in Nursing. 2017; 13: 624–627.

[9] Freire JR, Costa MV da, Magnago C, Forster AC. Actitudes para la colaboración interprofesional de equipos de Atención Primaria participantes del Programa Más Médicos. Rev Latino-Am Enfer-magem. 2018. Available at: https://www.scielo.br/j/rlae/a/yRyQcJHmw3sfKJTP8HtLMBD/?lang=es (Accessed: 28 June 2021).

[10] Palaganas JC, Brunette V, Winslow B. Prelicensure Simulation-Enhanced Interprofessional Education: a Critical Review of the Research Literature. Simulation in Healthcare. 2016; 11: 404–418.

[11] INACSL Standards of Best Practice: SimulationSM Simulation Design. Clinical Simulation in Nursing. 2016; 12: S5–S12.

[12] Bagnasco A, Tubino B, Piccotti E, Rosa F, Aleo G, Di Pietro P, et al. Identifying and correcting communication failures among health professionals working in the Emergency Department. International Emergency Nursing. 2013; 21: 168–172.

[13] Komasawa N, Berg B. Interprofessional Simulation Training for Periop-erative Management Team Development and Patient Safety. Journal of Perioperative Practice. 2016; 26: 250–253.

[14] Reime MH, Johnsgaard T, Kvam FI, Aarflot M, Engeberg JM, Breivik M, et al. Learning by viewing versus learning by doing: a comparative study of observer and participant experiences during an interprofessional simulation training. Journal of Interprofessional Care. 2017; 31: 51–58.

[15] Bristowe K, Siassakos D, Hambly H, Angouri J, Yelland A, Draycott TJ, et al. Teamwork for clinical emergencies: interprofessional focus group analysis and triangulation with simulation. Qualitative Health Research. 2012; 22: 1383–1394.

[16] Hernández E, Camacho M, Leal-Costa C, Ruzafa-Martínez M, Ramos-Morcillo AJ, Cazorla E, et al. Does Multidisciplinary Team Simulation-Based Training Improve Obstetric Emergencies Skills? Healthcare. 2021; 9.

[17] Glaser BG, Strauss AL. Discovery of Grounded Theory: Strategies for Qualitative Research. Routledge. 2017; 282.

[18] Rutherford-Hemming T, Lioce L, Breymier T. Guidelines and Essential Elements for Prebriefing. Simulation in Healthcare. 2019; 14: 409–414.

[19] Tyerman J, Luctkar-Flude M, Graham L, Coffey S, Olsen-Lynch E. Pre-simulation preparation and briefing practices for healthcare professionals and students. JBI Database of Systematic Reviews and Implementation Reports. 2016; 14: 80–89.

[20] Cheng A, Palaganas J, Eppich W, Rudolph J, Robinson T, Grant V. Co-debriefing for simulation-based education: a primer for facilitators. Simulation in Healthcare. 2015; 10: 69–75.

[21] Hsieh H, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005; 15: 1277–1288.

[22] Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced Nursing. 2008; 62: 107–115.

[23] Darawsheh W. Reflexivity in research: Promoting rigour, reliability and validity in qualitative research. International Journal of Therapy and Rehabilitation. 2014; 21: 560–568.

[24] Weil A, Weldon SM, Kronfli M, Watkins B, Kneebone R, Bello F, et al. A new approach to multi-professional end of life care training using a sequential simulation (SqS SimulationTM ) design: A mixed methods study. Nurse Education Today. 2018; 71: 26–33.

[25] Fransen A, van de Ven J, Schuit E, van Tetering A, Mol B, Oei S. Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2017; 124: 641–650.

[26] Liaw SY, Ooi SW, Rusli KDB, Lau TC, Tam WWS, Chua WL. Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes. Journal of Medical Internet Research. 2020; 22: e17279.

[27] Roh YS, Ahn J, Kim E, Kim J. Effects of Prebriefing on Psychological Safety and Learning Outcomes. Clinical Simulation in Nursing. 2018; 25: 12–19.

[28] Page-Cutrara K. Prebriefing in Nursing Simulation: a Concept Analysis. Clinical Simulation in Nursing. 2015; 11: 335–340.

[29] Díaz-Agea JL, Pujalte-Jesús MJ, Leal-Costa C, García-Méndez JA, Adánez-Martínez MG, Jiménez-Rodríguez D. Motivation: bringing up the rear in nursing education. Motivational elements in simulation. the participants’ perspective. Nurse Education Today. 2021; 103: 104925.

[30] INACSL Standards of Best Practice: SimulationSM Debriefing. Clinical Simulation in Nursing. 2016; 12: S21–S25.

[31] Alinier G. Developing High-Fidelity Health Care Simulation Scenarios: a Guide for Educators and Professionals. Simulation & Gaming. 2011; 42: 9–26.

[32] Poore JA, Dawson JC, Dunbar D, Parrish K. Debriefing Interprofession-ally: a Tool for Recognition and Reflection. Nurse Educator. 2019; 44: 25–28.

[33] Committee IS. INACSL standards of best practice: SimulationSM facilitation. Clinical Simulation in Nursing. 2016; 12: S16–S20.

[34] Kelly M, Guinea S. Facilitating healthcare simulations (pp. 143–151). En: Healthcare Simulation Education. John Wiley & Sons, Ltd. 2017. Available at: https://onlinelibrary.wiley.com/doi/abs/10. 1002/9781119061656.ch19 (Accessed: 9 October 2020).

[35] Brown DK, Wong AH, Ahmed RA. Evaluation of simulation debriefing methods with interprofessional learning. Journal of Interprofessional Care. 2018; 32: 779–781.

[36] Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simulation in Healthcare. 2014; 9: 339–349.

[37] Sharoff L. Simulation: Pre-briefing Preparation, Clinical Judgment and Reflection. What is the Connection? Çağdaş Tıp Dergisi. 2015; 5: 88–101.

[38] Omura M, Maguire J, Levett-Jones T, Stone TE. The effectiveness of assertiveness communication training programs for healthcare pro-fessionals and students: a systematic review. International Journal of Nursing Studies. 2017; 76: 120–128.